565850142-7-18-2023-29-AS-DPEA-CU4QLK-20230726121603

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565850142
Report Date: 07/18/2023
Date Signed: 07/18/2023 11:32:43 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/14/2022 and conducted by Evaluator Kelly Dulek

PUBLIC

COMPLAINT CONTROL NUMBER: 29-AS-20221114114311

FACILITY NAME:	CAMARILLO SENIOR LIVING		FACILITY NUMBER:	565850142
ADMINISTRATOR:	GONZAGA, VINCENT		FACILITY TYPE:	741
ADDRESS:	6000 SANTA ROSA ROAD		TELEPHONE:	(805) 388-8086
CITY:	CAMARILLO	STATE: CA	ZIP CODE:	93012
CAPACITY:	140	CENSUS: 53	DATE:	07/18/2023
		UNANNOUNCED	TIME BEGAN:	11:08 AM
MET WITH:	Gena Grundeis		TIME COMPLETED:	11:35 AM

ALLEGATION(S):

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Facility is understaffed

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kelly Dulek conducted a subsequent complaint inspection with the purpose of delivering findings for the above listed allegation. LPA met with Executive Director Gena Grundeis at 11:08AM. Entrance interview conducted.

During an initial complaint visit conducted on 11/16/2022, LPA interviewed Executive Director Okhawere (Misi) Ahanmisi at 10:20AM, toured the facility with Activities Director at 10:33AM, interviewed staff between 10:49AM and 1:00PM. LPA received copies of documents pertinent to the investigation. During an unrelated facility visit, LPA interviewed residents related to this complaint allegation. LPA then reviewed pertinent documents and all information obtained during interviews. The following was then determined:

Report Continued on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Kelly Dulek	TELEPHONE: (951) 836-3170
LICENSING EVALUATOR SIGNATURE:	DATE: 07/18/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20221114114311

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: CAMARILLO SENIOR LIVING	FACILITY NUMBER: 565850142
	VISIT DATE: 07/18/2023

NARRATIVE

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The complaint alleges that the facility had cut staffing and that there was only one staff scheduled in the Memory Care unit and one staff scheduled in the Assisted Living side. Interviews revealed that staffing patterns did recently change, based on the census at the facility. At the time of the initial visit, the facility had 10 residents in the Memory Care unit and 44 in Assisted Living. Staff interviews revealed that there are currently 3 care staff working in the Assisted Living unit as well as 2 care staff in the Memory Care unit, which is also reflected in the staff schedule obtained. Recently, in the Memory Care unit, there is one care staff working during the shift and one medication tech; both staff scheduled during the shift provide care to the residents in Memory Care. Staff interviewed indicated there are fewer residents than previously, which is why the adjustment in staffing has been made. Staff stated many of the residents in Assisted Living are relatively independent and do not require as much hands-on assistance, therefore, the decrease in care staff is manageable. In Memory Care, interviews revealed that due to the lower amount of residents, the time needed to assist residents with medications is minimal, only about 1-2 hours during an 8-hour shift. So, the medication technician is able to spend the remainder of their time at work assisting with the 10 residents’ care needs. Additionally, staff interviews revealed that during the day when residents require more assistance, there are managerial staff and activities staff available to step in and assist as needed. Residents interviewed indicated they believe their care needs are being met and that staff are kind and responsive to their needs. Based on interview and record review, although the allegation may be valid, at this time there is insufficient evidence to support the allegation or that a violation occurred, therefore, the allegation “facility is understaffed” is deemed UNSUBSTANTIATED at this time.

No citations issued. Exit interview conducted. A copy of the report was provided.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Kelly Dulek	TELEPHONE: (951) 836-3170
LICENSING EVALUATOR SIGNATURE:	DATE: 07/18/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2023

LIC9099 (FAS) - (06/04)

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